Another poop question:/

Ok ladies. I read all these poop boards.. But I would like to ask some questions. We have a big issue with constipation and I'm realizing that it's awful for them to be constipated. I have him on mirilax. But right now we are super constipated these liquid glycerin suppositories? Is there a certain brand?? He is 10 months old.
What is senna? Is that something you would give him? I don't have a bowel program. I know I need one. I just don't know what to do.
He has his first GI appt on the 23rd of August. From what you all say it's pointless to go? I feel incredibly clueless.

I'm just having one of those days where I'm grieving the 'what I thought my life would be like'... Some days it's just so hard!! Thank you ladies. This board is an incredible source of info and support.

Pedialax makes the most common liquid glycerin suppositories, if you are in the US.

Suggestion is to do a full clean-out using Miralax and suppositories and then establish a routine involving Miralax, prunes and suppositories regularly.

A clean-out means giving doses of Miralax as frequently as possible until you get pure running tea consistency liquid out. Don't stop til you get that. Once it's done, takes 3-5 days, you start a new routine to make sure he doesn't get constipated again.

How much poop are you getting every day and what consistency is it?
Pedialax ...

Posted
08/08/2017

How much poop are you getting every day and what consistency is it?

Pedialax makes the most common liquid glycerin suppositories, if you are in the US.

Suggestion is to do a full clean-out using Miralax and suppositories and then establish a routine involving Miralax, prunes and suppositories regularly.

A clean-out means giving doses of Miralax as frequently as possible until you get pure running tea consistency liquid out. Don't stop til you get that. Once it's done, takes 3-5 days, you start a new routine to make sure he doesn't get constipated again.

Well. Right now it's a few hard balls. I know that's bad! Seems like he can be doing good and then he just stops up again. Would you feed him prune baby food or the juice? Okay. I'll try that. He takes bottles, so would you put some mirilax in every bottle? If so, how much?

Give him a dose of Miralax (whatever amount you have been giving him) at least every 3-4 hours and do so until you get liquid tea consistency out. Add extra fluid to his diet to keep him from getting dehydrated.

Balls are bad. Start this immediately. The damage being done now by him being constipated is going to take months or years to heal and can affect his ability to be socially continent.

You need to get at least half to a full cup of poop EVERY day and it NEEDS to be soft serve consistency.

At 10 months old, your options are more limited for what is safe. But first, some understanding...

"Neurogenic bowel" means that the peristalsis action of the colon (the coordinated squeezing of the smooth muscle of the large intestine) is either weak or non-existant. Furthermore, the ability to feel that the rectum is full is likely missing, as well as the ability to push out stool from that section. And then you add in that there will be little to no tone in the actual anus (allowing everything to pass through... usually). But, it doesn't take any muscle at all to pull the water/nutrients out of what's going through, because that's just plain old osmosis. (kind of amazing that we're designed that way, ain't it?).

So, the major issue with our kiddos is that things tend to just hang out, leading to a gumming up of the works. A.k.a. "Constipation" (big C).

Here's where big C gets diabolical, though. The more the colon gets stretched out, the less the smooth muscles are able to work. This is true for ANY ONE, of ANY age, of ANY ability. If you have a toddler who prevents themselves from pooping (pyschological reasons), eventually, the stretched out colon will be incapable of pushing out poop, even if that child tries. And it can take months, even years for the colon to have function restore if it gets to that point. In our kiddos, where the smooth muscle tissue is already impaired, this is extremely, extremely, EXTREMELY no bueno.

In infants, breastmilk is already highly digested, and contains wonderful, natural laxative properties (stimulate some peristalsis). So, the fact that it moves through slowly isn't worrisome, because it just keeps moving. As they eat a little bit and add to the top, it pushes out a little at the bottom.

Enter actual food. No more natural laxative properties + takes more time just to digest. Constipation is pretty much inevitable.

Truths to know:

1) Understand that anything from the "top down" will take - at MINIMUM - 24-48 hours to work through to the bottom. So, if you stopped doing some intervention (prunes, mirilax) because today is good, then either tomorrow or the next day is when you find yourself backed up again. Sound familiar?

2) Nuggets are BAD. Rabbit turds means that the poop has been stuck in the colon for SO (significant other) long that every. single. possible. DROP of water has been pulled out of it. That is way, way, WAY too long.

3) Diarrhea can actually be evidence of super severe constipation, too. If the colon is at "rabbit turd" level, and gets even worse to the point that even the rabbit turds can't get out, then what can get out? That's right, the stuff that is completely liquid in consistency. At least, until THAT backs up, too. Occasionally, the liquid stool can help some of those rabbit turds to come through, but it will never get them all out. Diarrhea can also be the result of the biome in the intestines being so super out of whack that digestion isn't working right any more - still evidence of constipation.

So, the approaches:

TOP DOWN

Foods that soften. (the "p" foods, generally. Although this can be somewhat individual. Prunes didn't help April much, but pears sure did! I know pears have constipated other kids, though. You really have to work to figure out the individual kid)

"adding fiber" This pretty much NEVER works in folks with SB (why I put that in quotes). But is almost universally recommended by pediatricians and GIs, because in folks that have normal peristalsis, super squishy poop is hard to effectively push out, so bulking it up = good. In our kids? They don't need help bulking it up. That's the problem! They need help getting it moved through.

Medication. Before about 16 months, the option is stool softeners of some sort. This can be food or pharmacy based. Black strap molasses or Karo syrup can help to soften poop (but add tremendous amounts of excess calories, which can create its own vicious cycle). Mirilax is a stool softener, and so is lactulose (which also has a little bit of a "stimulate peristalis" quality). These are all very hard to "overdose" on, because it would just mean the poop is too runny, and the risk is from dehydration. Simple solution if that starts to happen: less stool softener, more fluids. Done.

**True "Laxatives" that stimulate peristalsis aren't something I ever recommend to pre-verbal kiddos. (senna, bisacodyl, dulcolax, etc) They can be overdosed on, pretty easily, and the first symptom of reaching overdose levels is painful cramping. In a kid whose only communication method is "holler!" trying to decipher whether it's tummy pain, teething pain, shunt issues, etc. is a nightmare. And guessing wrong would have serious, serious consequences.

BOTTOM-UP approach

The "lube it and stick it" approach. Q-tips were very helpful for me (less ick factor), but I know pinkies are popular. Help the rectum to open a little further, allowing stool that's stuck at the doorstep to come out.

Liquid glycerine suppositories. (generally called "PediaLax" with the penguin on the box) It's just a funky type of sugar that will help to soften the poop that's in the rectum, as well as lubricate it to pass through. Supposedly, it creates a little bit of peristaltic action, too, but I never had evidence of that. Glycerine is in a LOT of foods, and pretty much all soaps. Go figure! Safe enough to do more than one, even more than one in a session of poop removal!

Enemas. Not generally recommended for the littlest ones. These (like "Fleets") often have other additives in them that can mess up the electrolytes and kidneys if used long term. If baby gets SUPER constipated, a hospital might administer ONE of these.

High-volume enema: cannot be done on a baby. This would be cone enemas, balloon enemas, or Peristeen. They're too small, too delicate, and would fall into the toilet if you tried to put them on the seat (and the "high volume" means that it would never, ever be contained in a diaper. EW!!).

So, to answer your question: What to do NOW?

Start with a top-down AND bottom-up approach, simultaneously. You need to get out every. single. rabbit-turd pellet. A "Mirilax cleanout" is the safest, most effective method I know of. (the other cleanout method would be a tummy bug or round of strong antibiotics. That became April's first "clean-out," and it was eye-opening. BUT, it's not an approach I recommend. Wasn't fun) When her "maintenance dose" was a 1/2 teaspoon of Mirilax, I was doing a FULL CAP dissolved in a little bit of water each morning and each night, with a TON of extra fluids being encouraged. (juice, pedialyte, whatever it took to hydrate her well). This would go on for 2-3 days before the initial pooplosion would happen. Keep pushing the Mirilax as the pooplosions continue, until it's tea consistency. At that point, I would dial back the Mirilax to the maintenance dosage (although, it sounds like your "maintenance dosage" needs to be quite a bit higher than you're doing right now. Just sayin').

From the bottom up (while doing Mirilax): Q-tip and lube for poop that's right at the doorstep, and then administer one (or two) liquid glycerine suppositories each morning AND each night. This will help to get the worst of the plug out of the way for the Mirilax to work its way down from the top.

Once you're at the "tea" consistency, palpate the abdomen thoroughly. It will be noticeably softer and squishier, especially along the periphery of the abdomen (where the large intestine/colon travels). You may also notice a sudden uptick in appetite! I noticed a dramatically happier baby, just all around. Talk about guilt! But, remember what this feels like, with their abdomen NOT all full of poop. I got to the point that I could tell exactly where she had poop building up, which was handy for figuring out whether a top-down approach or bottom-up approach might work faster, or later, whether she was actually done with her enema-induced pooplosion or had a little more working its way down yet. X-rays have only ever confirmed what my fingers on her abdomen told me. Pretty handy!

At 10 months old, your options are more limited for what is safe. But first, ...

Posted
08/08/2017

At 10 months old, your options are more limited for what is safe. But first, some understanding...

"Neurogenic bowel" means that the peristalsis action of the colon (the coordinated squeezing of the smooth muscle of the large intestine) is either weak or non-existant. Furthermore, the ability to feel that the rectum is full is likely missing, as well as the ability to push out stool from that section. And then you add in that there will be little to no tone in the actual anus (allowing everything to pass through... usually). But, it doesn't take any muscle at all to pull the water/nutrients out of what's going through, because that's just plain old osmosis. (kind of amazing that we're designed that way, ain't it?).

So, the major issue with our kiddos is that things tend to just hang out, leading to a gumming up of the works. A.k.a. "Constipation" (big C).

Here's where big C gets diabolical, though. The more the colon gets stretched out, the less the smooth muscles are able to work. This is true for ANY ONE, of ANY age, of ANY ability. If you have a toddler who prevents themselves from pooping (pyschological reasons), eventually, the stretched out colon will be incapable of pushing out poop, even if that child tries. And it can take months, even years for the colon to have function restore if it gets to that point. In our kiddos, where the smooth muscle tissue is already impaired, this is extremely, extremely, EXTREMELY no bueno.

In infants, breastmilk is already highly digested, and contains wonderful, natural laxative properties (stimulate some peristalsis). So, the fact that it moves through slowly isn't worrisome, because it just keeps moving. As they eat a little bit and add to the top, it pushes out a little at the bottom.

Enter actual food. No more natural laxative properties + takes more time just to digest. Constipation is pretty much inevitable.

Truths to know:

1) Understand that anything from the "top down" will take - at MINIMUM - 24-48 hours to work through to the bottom. So, if you stopped doing some intervention (prunes, mirilax) because today is good, then either tomorrow or the next day is when you find yourself backed up again. Sound familiar?

2) Nuggets are BAD. Rabbit turds means that the poop has been stuck in the colon for SO long that every. single. possible. DROP of water has been pulled out of it. That is way, way, WAY too long.

3) Diarrhea can actually be evidence of super severe constipation, too. If the colon is at "rabbit turd" level, and gets even worse to the point that even the rabbit turds can't get out, then what can get out? That's right, the stuff that is completely liquid in consistency. At least, until THAT backs up, too. Occasionally, the liquid stool can help some of those rabbit turds to come through, but it will never get them all out. Diarrhea can also be the result of the biome in the intestines being so super out of whack that digestion isn't working right any more - still evidence of constipation.

So, the approaches:

TOP DOWN

Foods that soften. (the "p" foods, generally. Although this can be somewhat individual. Prunes didn't help April much, but pears sure did! I know pears have constipated other kids, though. You really have to work to figure out the individual kid)

"adding fiber" This pretty much NEVER works in folks with SB (why I put that in quotes). But is almost universally recommended by pediatricians and GIs, because in folks that have normal peristalsis, super squishy poop is hard to effectively push out, so bulking it up = good. In our kids? They don't need help bulking it up. That's the problem! They need help getting it moved through.

Medication. Before about 16 months, the option is stool softeners of some sort. This can be food or pharmacy based. Black strap molasses or Karo syrup can help to soften poop (but add tremendous amounts of excess calories, which can create its own vicious cycle). Mirilax is a stool softener, and so is lactulose (which also has a little bit of a "stimulate peristalis" quality). These are all very hard to "overdose" on, because it would just mean the poop is too runny, and the risk is from dehydration. Simple solution if that starts to happen: less stool softener, more fluids. Done.

**True "Laxatives" that stimulate peristalsis aren't something I ever recommend to pre-verbal kiddos. (senna, bisacodyl, dulcolax, etc) They can be overdosed on, pretty easily, and the first symptom of reaching overdose levels is painful cramping. In a kid whose only communication method is "holler!" trying to decipher whether it's tummy pain, teething pain, shunt issues, etc. is a nightmare. And guessing wrong would have serious, serious consequences.

BOTTOM-UP approach

The "lube it and stick it" approach. Q-tips were very helpful for me (less ick factor), but I know pinkies are popular. Help the rectum to open a little further, allowing stool that's stuck at the doorstep to come out.

Liquid glycerine suppositories. (generally called "PediaLax" with the penguin on the box) It's just a funky type of sugar that will help to soften the poop that's in the rectum, as well as lubricate it to pass through. Supposedly, it creates a little bit of peristaltic action, too, but I never had evidence of that. Glycerine is in a LOT of foods, and pretty much all soaps. Go figure! Safe enough to do more than one, even more than one in a session of poop removal!

Enemas. Not generally recommended for the littlest ones. These (like "Fleets") often have other additives in them that can mess up the electrolytes and kidneys if used long term. If baby gets SUPER constipated, a hospital might administer ONE of these.

High-volume enema: cannot be done on a baby. This would be cone enemas, balloon enemas, or Peristeen. They're too small, too delicate, and would fall into the toilet if you tried to put them on the seat (and the "high volume" means that it would never, ever be contained in a diaper. EW!!).

So, to answer your question: What to do NOW?

Start with a top-down AND bottom-up approach, simultaneously. You need to get out every. single. rabbit-turd pellet. A "Mirilax cleanout" is the safest, most effective method I know of. (the other cleanout method would be a tummy bug or round of strong antibiotics. That became April's first "clean-out," and it was eye-opening. BUT, it's not an approach I recommend. Wasn't fun) When her "maintenance dose" was a 1/2 teaspoon of Mirilax, I was doing a FULL CAP dissolved in a little bit of water each morning and each night, with a TON of extra fluids being encouraged. (juice, pedialyte, whatever it took to hydrate her well). This would go on for 2-3 days before the initial pooplosion would happen. Keep pushing the Mirilax as the pooplosions continue, until it's tea consistency. At that point, I would dial back the Mirilax to the maintenance dosage (although, it sounds like your "maintenance dosage" needs to be quite a bit higher than you're doing right now. Just sayin').

From the bottom up (while doing Mirilax): Q-tip and lube for poop that's right at the doorstep, and then administer one (or two) liquid glycerine suppositories each morning AND each night. This will help to get the worst of the plug out of the way for the Mirilax to work its way down from the top.

Once you're at the "tea" consistency, palpate the abdomen thoroughly. It will be noticeably softer and squishier, especially along the periphery of the abdomen (where the large intestine/colon travels). You may also notice a sudden uptick in appetite! I noticed a dramatically happier baby, just all around. Talk about guilt! But, remember what this feels like, with their abdomen NOT all full of poop. I got to the point that I could tell exactly where she had poop building up, which was handy for figuring out whether a top-down approach or bottom-up approach might work faster, or later, whether she was actually done with her enema-induced pooplosion or had a little more working its way down yet. X-rays have only ever confirmed what my fingers on her abdomen told me. Pretty handy!

Hope this helps!

Wow. This is a LOT of amazing information. Priceless. And I thank you so much! I'm gonna have to read this one a few times.

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